| NPI | 1093137440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA PC014797) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.008817) |
| Enumeration Date | 2014-01-19 |
| Last Update Date | 2023-02-08 |